Kommerell's diverticulum and aneurysmal right-sided aortic arch: A case report and review of the literature

Right-sided aortic arch is a rare variant of the thoracic vascular anatomy that may be accompanied by an aberrant origin of the left subclavian artery . We report a true aneurysm of the distal arch and descending thoracic aort a in a patient with right-sided arch and review previous descriptions of an eurysms of anomalous right-sided aortas. In our patient, the left subclavia n artery originated at the junction between the distal arch and the descend ing thoracic aorta located in the right chest and was aneurysmal (Kommerell 's diverticulum); the thoracic aorta was also aneurysmal. Extra-anatomic le ft subclavian-to-carotid transposition was performed before the intrathorac ic procedure. Subsequently, a right thoracotomy provided adequate exposure for repairing the aortic aneurysm and oversewing the aneurysmal origin of t he subclavian artery. Because the distal aortic arch was involved, deep hyp othermia and circulatory arrest were used, Only five previous instances of true aneurysms of a right-sided aortic arch have been reported; four of the se patients underwent operative repair (via bilateral thoracotomy, median s ternotomy, or right thoracotomy). We believe that a right thoracotomy provi des good exposure and avoids the morbidity associated with bilateral thorac otomy. The reconstruction of the subclavian artery has not previously been reported in this setting. Performing subclavian reconstruction as an extrat horacic procedure before the intrathoracic repair would be expected to redu ce the subsequent risk of distal ischemia or subclavian steal without incre asing the overall morbidity associated with the procedure.